McCormick Jeremy J, Johnson Jeffrey E
Department of Orthopedic Surgery, Foot and Ankle Service, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
Foot Ankle Clin. 2012 Jun;17(2):283-98. doi: 10.1016/j.fcl.2012.03.003.
AAFD is a complex problem with a wide variety of treatment options. No single procedure or group of procedures can be applied to all patients with AAFD because of the variety of underlying etiology and grades of deformity. As the posture of the foot progresses into hindfoot valgus and forefoot abduction through attenuation of the medial structures of the foot, the medial column begins to change shape. The first ray elevates and the joints of the medial column may begin to collapse. Careful physical examination and review of weight-bearing radiographs determines which patients have an associated forefoot varus deformity that may require correction at the time of flatfoot reconstruction. Correction of an AAFD requires a combination of soft-tissue procedures to restore dynamic inversion power and bony procedures to correct the hindfoot and midfoot malalignments. If after these corrections forefoot varus deformity remains, the surgeon should consider use of a medial column procedure to recreate the “triangle of support” of the foot that Cotton described.5 If the elevation of the medial column is identified to be at the first NC or the first TMT joint, then the joint should be carefully examined for evidence of instability, hypermobility, or arthritic change. If none of these problems exist, then the surgeon can consider use of the joint-sparing Cotton medial cuneiform osteotomy to correct residual forefoot varus. However, if instability, hypermobility, or arthritic change is present, then the surgeon should consider use of an arthrodesis of the involved joint to correct residual forefoot varus. Either procedure provides a safe and predictable correction to the medial column as part of a comprehensive surgical correction of AAFD.
成人获得性平足症（AAFD）是一个复杂的问题，有多种治疗选择。由于潜在病因和畸形程度的多样性，没有单一的手术或一组手术可以应用于所有AAFD患者。随着足部姿势通过足部内侧结构的衰减发展为后足外翻和前足外展，内侧柱开始改变形状。第一跖骨抬高，内侧柱的关节可能开始塌陷。仔细的体格检查和负重X线片检查可确定哪些患者伴有前足内翻畸形，这可能需要在扁平足重建时进行矫正。矫正AAFD需要结合软组织手术以恢复动态内翻力量和骨手术以矫正后足和中足的排列不齐。如果在这些矫正后前足内翻畸形仍然存在，外科医生应考虑使用内侧柱手术来重建Cotton所描述的足部“支撑三角”。如果确定内侧柱的抬高位于第一跖楔关节或第一跖跗关节，则应仔细检查该关节是否存在不稳定、活动过度或关节炎改变的证据。如果不存在这些问题，那么外科医生可以考虑使用保留关节的Cotton内侧楔骨截骨术来矫正残留的前足内翻。然而，如果存在不稳定、活动过度或关节炎改变，那么外科医生应考虑对受累关节进行关节融合术来矫正残留的前足内翻。作为AAFD综合手术矫正的一部分，这两种手术都能对内侧柱提供安全且可预测的矫正。
